Reduced nocturnal blood pressure (BP) decrease (non-dipping) is associated with increased cardiovascular morbidity and mortality in adult patients with end-stage renal failure (ESRF) or primary hypertension (HT). In children, only limited data mainly in ESRF patients exist showing similar prediction of left ventricular hypertrophy (LVH) by nocturnal BP dip or nocturnal BP values. The aim of our study was to investigate whether nocturnal blood pressure (BP) dip is associated with increased left ventricular mass index and hypertrophy in children with hypertension (HT).

Material and methods:

We retrospectively reviewed data from all children with confirmed ambulatory HT in our centre and performed ambulatory blood pressure monitoring (ABPM) and echocardiography at the same time. Left ventricular hypertrophy (LVH) was defined as left ventricular mass index (LVMI) ≥95th centile. BP index as patient´s BP/95th percentile.

Results:

A total of 114 ABPM studies were included, the median age of children was 15.3 years (3.8 – 18.9), 80 children had renoparenchymal HT without end-stage renal failure and 34 had primary HT, 27 studies were done on untreated children and 87 on treated children. Non-dipping phenomenon was present in 63 (55%) studies (non-dippers). The LVMI adjusted for age was not significantly different between non-dippers and dippers (0.87 ± 0.03 vs. 0.81 ± 0.02, p=0.13). Left ventricular hypertrophy was not significantly higher in non-dippers than in dippers (20% vs. 9%, p=0.12). Age (p=0.004) and nighttime diastolic BP index (p=0.030) were the only independently associated predictors for LVMI.

Conclusions:

Hypertensive children without end-stage renal failure with non-dipping phenomenon do not have increased prevalence of LVH or higher LVMI adjusted for age than hypertensive children with preserved nocturnal BP dip. The only independent BP predictors of LVMI is nocturnal diastolic BP index and not nocturnal BP dipping status.